Prevalence, agreement and classification of various metabolic syndrome criteria among ethnic Chinese: a report on the hospital-based health diagnosis of the adult population

Novel Insights into the Pathogenesis and Management of the Metabolic Syndrome

The metabolic syndrome, by definition, is not a disease but is a clustering of individual metabolic risk factors including abdominal obesity, hyperglycemia, hypertriglyceridemia, hypertension, and low high-density lipoprotein cholesterol levels. These risk factors could dramatically increase the prevalence of type 2 diabetes and cardiovascular disease. The reported prevalence of the metabolic syndrome varies, greatly depending on the definition used, gender, age, socioeconomic status, and the ethnic background of study cohorts. Clinical and epidemiological studies have clearly demonstrated that the metabolic syndrome starts with central obesity. Because the prevalence of obesity has doubly increased worldwide over the past 30 years, the prevalence of the metabolic syndrome has markedly boosted in parallel. Therefore, obesity has been recognized as the leading cause for the metabolic syndrome since it is strongly associated with all metabolic risk factors. High prevalence of the metabolic syndrome is not unique to the USA and Europe and it is also increasing in most Asian countries. Insulin resistance has elucidated most, if not all, of the pathophysiology of the metabolic syndrome because it contributes to hyperglycemia. Furthermore, a major contributor to the development of insulin resistance is an overabundance of circulating fatty acids. Plasma fatty acids are derived mainly from the triglycerides stored in adipose tissues, which are released through the action of the cyclic AMP-dependent enzyme, hormone sensitive lipase. This review summarizes the latest concepts in the definition, pathogenesis, pathophysiology, and diagnosis of the metabolic syndrome, as well as its preventive measures and therapeutic strategies in children and adolescents.

Differential effects of saturated fatty acids on the risk of metabolic syndrome: a matched case-control and meta-analysis study

BACKGROUND

We investigated the association between plasma saturated fatty acids (SFAs) and the risk of metabolic syndrome among ethnic Chinese adults in Taiwan who attended a health check-up center.

METHODS

A case-control study based on 1000 cases of metabolic syndrome and 1:1 matched control participants (mean age, 54.9 ± 10.7 y; 36% females) were recruited. Metabolic syndrome was defined according to the criteria of the International Diabetes Federation. Gas chromatography was used to measure the distribution of fatty acids in plasma (% of total fatty acids).

RESULTS

Even-chain SFAs, including 14:0, 16:0, and 18:0, were associated with metabolic syndrome; the adjusted odds ratio [OR] and 95% confidence interval [CI] per standard deviation [SD] difference was 3.32, [1.98-5.59]; however, very-long-chain SFAs, including 20:0, 21:0, 22:0, 23:0, and 24:0, were inversely associated with metabolic syndrome. The adjusted OR [95% CI] per SD difference was 0.67 [0.58-0.78]. The area under the receiver operative characteristic curve increased from 0.814 in the basic model to 0.815 (p = 0.54, compared with the basic model), 0.818 (p < 0.0001), and 0.820 (p < 0.0001) after adding odd-chain, even-chain, and very-long chain SFAs. A meta-analysis based on 12 studies showed that the summarized OR for type 2 diabetes mellitus was 1.16 [0.96-1.41] for the top versus bottom SFAs.

CONCLUSIONS

Different carbon numbers of SFAs have been shown to have differential effects on the status of metabolic syndrome, implying that SFAs are not homogenous for the effects.

Comparing the Consistency and Performance of Various Coronary Heart Disease Prediction Models for Primary Prevention Using a National Representative Cohort in Taiwan

BACKGROUND

Predicting future coronary artery disease (CAD) risk by model-based approaches can facilitate identification of high-risk individuals for prevention and management. Therefore, we compared the consistency and performance of various CAD models for primary prevention using 1 external validation dataset from a national representative cohort in Taiwan.Methods and Results:The 10 CAD prediction models were assessed in a validation cohort of 3559 participants (≥35 years old, 53.5% women) from a Taiwanese national representative cohort that was followed up for a median 9.70 (interquartile range, 9.63-9.74) years; 63 cases were documented as developing CAD events. The overall κ value was 0.51 for all 10 models, with a higher value for women than for men (0.53 for women, 0.40 for men). In addition, the areas under the receiver operating characteristics curves ranged from 0.804 (95% confidence interval, 0.758-0.851) to 0.847 (95% confidence interval, 0.805-0.889). All non-significant chi-square values indicated good calibration ability.

CONCLUSIONS

Our study demonstrated these 10 CAD prediction models for primary prevention were feasible and validated for use in Taiwanese subjects. Further studies of screening and management are warranted.

Mini-Review of the Chin-Shan Community Cardiovascular Cohort Study in Population Health Research in Taiwan

Preventing and controlling non-communicable diseases (NCDs) is a growing global public health concern, and evidence-based data from population-based health studies are needed in order to develop appropriate public health policies for controlling NCDs. The Chin-Shan Community Cardiovascular Cohort (CCCC) study is a prospective cohort consisting of participants from one community in China in 1990-1991, and has provided substantial evidence-based data on domestic and global health issues in preventive cardiology fields. The present study is a mini-review of the CCCC study. In this review, we have described the historical background of the cardiovascular disease burden and related risk factors, especially lifestyle factors, subclinical disease markers, biomarkers and prediction models, and related international collaborative projects. In addition, this mini-review study provides a measure of insight into future plans for 21st century epidemiological research in cardiovascular diseases, suggesting possible areas of focus for future research.

Optimal cut-off levels of obesity indices by different definitions of metabolic syndrome in a southeast rural Chinese population

AIMS/INTRODUCTION

The aim of the present study was to compare the cut-off values and prediction effect of different obesity indices by different definitions of metabolic syndrome (MetS) in Zhejiang Province of China.

MATERIALS AND METHODS

We carried out a cross-sectional survey of 10,100 individuals (age 40 years and older) in Jiashan, Zhejiang Province. Receiver operating characteristic analysis was used to examine discrimination and find optimal cut off values of waist circumference (WC), body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) to predict two or more non-adipose components of MetS by The National Cholesterol Education Program Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III) definition modified by the Asia-Pacific region criteria, International Diabetes Federation definition for the Chinese population and Chinese Diabetes Society definitions of MetS.

RESULTS

The age-standardized prevalence of MetS was 23.78% vs 28.76% vs 19.37% by The National Cholesterol Education Program Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III), International Diabetes Federation and Chinese Diabetes Society definitions, respectively. Cut-off values of BMI were approximately 24 kg/m(2) both in men and women by three definitions; the average cut-off values of WC, WHR and WHtR were 83 cm in men vs 81 cm in women, 0.89 in men vs 0.86 in women and 0.50 in men vs 0.51 in women, respectively. The area under receiver operating characteristic curve of BMI was larger than WC both in men and women (P < 0.05); in women, the area under receiver operating characteristic curve of WHtR was larger than WC, and WHR was smaller.

CONCLUSIONS

MetS is prevalent in Zhejiang Province of China, especially in the female population. BMI and WHtR might be more useful than WC and WHR for predicting two or more non-adipose components of MetS.

The Cohort Study on Prediction of Incidence of All-Cause Mortality by Metabolic Syndrome

AIM

The aim was to evaluate the impact of metabolic syndrome (MS), MS individual components and 32 kinds of MS specific component combinations on all-cause mortality risk in a fixed cohort of MJ check-up population.

METHODS

We observed the events of death in a fixed cohort, where the population was composed of 45,542 individuals aged 35-74 who were examined at MJ Health check-up Center in 1997 as baseline examination, and were followed up to 2005. Median duration of follow-up was 7.44 years. MS was defined according to the National Cholesterol Educational Program (the revised NCEP-ATPIII for Asian in 2004), the prevalence of MS was standardized according to China's fifth census data. We constructed common Cox regression model, simultaneously adjusting the classic risk factors (such as age, sex, smoking, alcohol drinking, physical activity, family history, etc.) to examine the relationship between MS, MS individual components and 32 kinds of MS specific component combinations on the occurrence of death with the fixed cohort.

RESULTS

The standardized prevalence of MS was 29.75% (male: 30.36%, female: 29.51%). There were 1,749 persons who died during the median 7.44-years follow-up, the mortality rate was 46 per 10,000 person years. The mortality rates were 71 and 35 per 10,000 person years for those with and without MS, respectively. After adjustment for age, sex and classical risk factors, compared with subjects without MS, the hazard ratio of all-cause mortality was 1.26 (95% CI: 1.14-1.40). The all-cause mortality were more highly significant than other combinations (P <0.05) when the following combinations exist: "elevated blood pressure", "elevated fasting plasma glucose + low high-density lipoprotein cholesterol", "elevated blood pressure + elevated triglyceride + elevated fasting plasma glucose", "elevated fasting plasma glucose + low high-density lipoprotein cholesterol + elevated blood pressure + elevated triglyceride". After adjusting age, sex and classical risk factors, the HRs for those with 0 to 5 components were 1, 1.22, 1.25, 1.33, 1.66, and 1.92, respectively. There was a significant dose-response relationship (P for liner trend <0.001) between the number of MS components and the risk of all-cause mortality in the overall fixed cohort sample.

CONCLUSION

In a large scale middle-aged Taiwan check-up population, MS may be associated with a much higher risk for all-cause mortality. These results may underline the fact that MS is a non-homogeneous syndrome and have a significant impact on detecting high-risk individuals suffering from metabolic disorders for preventing and controlling death.

Insulin-like growth factor-1 deficiency and metabolic syndrome

Consistent evidence associates IGF-1 deficiency and metabolic syndrome. In this review, we will focus on the metabolic effects of IGF-1, the concept of metabolic syndrome and its clinical manifestations (impaired lipid profile, insulin resistance, increased glucose levels, obesity, and cardiovascular disease), discussing whether IGF-1 replacement therapy could be a beneficial strategy for these patients. The search plan was made in Medline for Pubmed with the following mesh terms: IGF-1 and "metabolism, carbohydrate, lipids, proteins, amino acids, metabolic syndrome, cardiovascular disease, diabetes" between the years 1963-2015. The search includes animal and human protocols. In this review we discuss the relevant actions of IGF-1 on metabolism and the implication of IGF-1 deficiency in the establishment of metabolic syndrome. Multiple studies (in vitro and in vivo) demonstrate the association between IGF-1 deficit and deregulated lipid metabolism, cardiovascular disease, diabetes, and an altered metabolic profile of diabetic patients. Based on the available data we propose IGF-1 as a key hormone in the pathophysiology of metabolic syndrome; due to its implications in the metabolism of carbohydrates and lipids. Previous data demonstrates how IGF-1 can be an effective option in the treatment of this worldwide increasing condition. It has to distinguished that the replacement therapy should be only undertaken to restore the physiological levels, never to exceed physiological ranges.

Common sequence variants in CD36 gene and the levels of triglyceride and high-density lipoprotein cholesterol among ethnic Chinese in Taiwan

Background

Evidence of the genetic association between CD36 candidate gene and the risk of metabolic syndrome and its components has been inconsistent. This case–control study assessed the haplotype-tagged SNPs from CD36 on the risk of metabolic syndrome and components.

Methods and results

We recruited 1,000 cases and age, gender-matched controls were randomly selected from the participants with metabolic syndrome defined by International Diabetes Federation. Overall, the haplotype tagged SNPs of CD36 gene were not related to the risk of metabolic syndrome. For individuals with normal lipid levels, several SNPs were significantly associated with the triglycerides and HDL-cholesterol levels: Subjects with rs3211848 homozygote had a higher triglyceride level (99.16 ± 2.61 mg/dL), compared with non-carriers (89.27 ± 1.45 mg/dL, P = 0.001). In addition, compared with non-carriers, individuals with rs1054516 heterozygous and homozygous genotypes had a significantly lower HDL-cholesterol (46.6 ± 0.46 mg/dL for non-carrier, 44.6 ± 0.36 mg/dL for heterozygous, and 44.3 ± 0.56 mg/dL for homozygous, P = 0.0008).

Conclusion

The CD36 gene variants were significantly associated with triglycerides and HDL-cholesterol concentrations among ethnic Chinese in Taiwan.

Relationship of adiposity and body composition to the status of metabolic syndrome among ethnic Chinese Taiwanese

BACKGROUND AND AIMS

The predictive power of adiposity and body compositions measured from bioelectrical impedance analysis (BIA) for identifying the risk of metabolic syndrome is unknown among ethnic Chinese.

METHODS AND RESULTS

We designed a nested case-control study by recruiting 1000 cases of metabolic syndrome and 986 matched controls from a health checkup center. For identifying the metabolic syndrome status, the highest areas under receiver operating characteristic curve (AUCs) were waist-height ratio (WHtR) (0.967, 95% confidence interval [CI], 0.960-0.976). The body fat mass vs. lean body mass and body mass index (BMI) had a similar AUC (0.896 for fat mass vs. lean body mass, 0886 for BMI, P=0.07). WHtR and waist circumference had the highest correctly classified proportions (0.89-0.90) and the highest Youden's index (0.77-0.81). The optimal cut point for WHtR was 52.5, with a sensitivity of 0.92 and specificity of 0.89 for discriminating metabolic syndrome risk. The incremental values of AUC, net reclassification improvement and integrated discrimination improvement values were still highest among WHtR, waist circumference and the percent body fat in the multivariate logistic model.

CONCLUSION

Waist circumference and BIA-derived body component measures are suitable for clinical application in identifying the metabolic syndrome status among ethnic Chinese in Taiwan.

Multilevel analysis of habitual physical activity and metabolic syndrome in Northern Taiwan

OBJECTIVE

This study examines the relationship between the availability of public facilities for habitual physical activity in the community and metabolic syndrome in northern Taiwan, one of most densely populated countries in the world.

METHODS

Subjects consisted of 14,658 participants (43.3% men and 56.7% women) ≥40 years old (mean=59.5) from 10 districts of Taoyuan County in a health check-up program in 2004-2005. Public facilities for habitual physical activity included school campuses and parks, and the density of such facilities was categorized into four levels. Multilevel logistic regression models were created to examine the effect on metabolic syndrome at both the individual and the contextual level using MLwiN software.

RESULTS

The addition of the contextual variable to the model that included individual characteristics led to a further reduction of 7.2% in the variance. Using the facility density level I as the reference, the odds ratios (95% confidence interval) of metabolic syndrome for levels II, III, and IV were 0.87 (0.71-1.07), 0.87 (0.68-1.12), and 0.78 (0.61-0.99), respectively, with the trend test reaching significance.

CONCLUSION

Greater availability of free facilities for habitual physical activity in a district was associated with a lower risk of metabolic syndrome among its residents.

Plasma fatty acids and the risk of metabolic syndrome in ethnic Chinese adults in Taiwan

Background

Evidence of predictive power of various fatty acids on the risk of metabolic syndrome was scanty. We evaluated the role of various fatty acids, including saturated fat, monounsaturated fat, transfat, n-6 fatty acid, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), for the risk of the metabolic syndrome in Taiwan.

Results

A nested case-control study based on 1000 cases of metabolic syndrome and 1:1 matched control subjects. For saturated fat, monounsaturated fat and transfat, the higher the concentration the higher the risk for metabolic syndrome: participants in the highest quintile had a 2.22-fold (95% confidence interval [CI], 1.66 to 2.97) higher risk of metabolic syndrome. In addition, the participants in higher EPA quintiles were less likely to have the risk of metabolic syndrome (adjusted risk, 0.46 [0.34 to 0.61] for the fifth quintile). Participants in the highest risk group (low EPA and high transfat) had a 2.36-fold higher risk of metabolic syndrome (95% CI, 1.38 to 4.03), compared with those in the lowest risk group (high EPA and low transfat). For prediction power, the area under ROC curves increased from 0.926 in the baseline model to 0.928 after adding fatty acids. The net reclassification improvement for metabolic syndrome risk was substantial for saturated fat (2.1%, P = 0.05).

Conclusions

Plasma fatty acid components improved the prediction of the metabolic syndrome risk in Taiwan.

Prediction model for high glycated hemoglobin concentration among ethnic Chinese in Taiwan

Background

This study aimed to construct a prediction model to identify subjects with high glycated hemoglobin (HbA1c) levels by incorporating anthropometric, lifestyle, clinical, and biochemical information in a large cross-sectional ethnic Chinese population in Taiwan from a health checkup center.

Methods

The prediction model was derived from multivariate logistic regression, and we evaluated the performance of the model in identifying the cases with high HbA1c levels (> = 7.0%). In total 17,773 participants (age > = 30 years) were recruited and 323 participants (1.8%) had high HbA1c levels. The study population was divided randomly into two parts, with 80% as the derivation data and 20% as the validation data.

Results

The point-based clinical model, including age (maximal 8 points), sex (1 point), family history (3 points), body mass index (2 points), waist circumference (4 points), and systolic blood pressure (3 points) reached an area under the receiver operating characteristic curve (AUC) of 0.723 (95% confidence interval, 0.677- 0.769) in the validation data. Adding biochemical measures such as triglycerides and HDL cholesterol improved the prediction power (AUC, 0.770 [0.723 - 0.817], P = < 0.001 compared with the clinical model). A cutoff point of 7 had a sensitivity of 0.76 to 0.96 and a specificity of 0.39 to 0.63 for the prediction model.

Conclusions

A prediction model was constructed for the prevalent risk of high HbA1c, which could be useful in identifying high risk subjects for diabetes among ethnic Chinese in Taiwan.

A prediction model for the risk of incident chronic kidney disease

BACKGROUND

Chronic kidney disease is a health burden for the general population. We designed a cohort study to construct prediction models for chronic kidney disease in the Chinese population.

METHODS

A total of 5168 participants were followed up during a median of 2.2 (interquartile range, 1.5-2.9) years, and 190 individuals (3.7%) developed chronic kidney disease, defined by a glomerular filtration rate of less than 60 mL/min/1.73 m(2).

RESULTS

We developed a point system to estimate chronic kidney disease risk at 4 years using the following variables: age (8 points), body mass index (2 points), diastolic blood pressure (2 points), and history of type 2 diabetes (1 point) and stroke (4 points) for the clinical model, with the addition of uric acid (2 points), postprandial glucose (1 point), hemoglobin A1c (1 point), and proteinuria 100 mg/dL or greater (6 points) for the biochemical model. Similar discrimination measures were found between the clinical model (area under the receiver operating characteristic curve, 0.768; 95% confidence interval (CI), 0.738-0.798) and the biochemical model (area under the receiver operating characteristic curve, 0.765; 95% CI, 0.734-0.796). The area under the receiver operating characteristic curve of the clinical model was 0.667 (95% CI, 0.631-0.703) for the external validation data from community-based cohort participants. The optimal cutoff value for the clinical model was set as 7, with a sensitivity of 0.76 and a specificity of 0.66.

CONCLUSION

We constructed a clinical point-based model to predict the 4-year incidence of chronic kidney disease. This prediction tool may help to target Chinese subjects at risk of developing chronic kidney disease.

Prevalence of the metabolic syndrome among rural original adults in NingXia, China

BACKGROUND

Metabolic syndrome (MS) is combination of medical disorders that increase people's risk for cardiovascular disease and diabetes mellitus. Little data exists on the prevalence of MS of rural original adults in Ningxia of China.

METHODS

A cross-sectional survey method was used and the participants were interviewed by trained health workers under a structured questionnaire in rural of Ningxia in 2008. The number of research subjects was 1612. MS was defined by International Diabetes Federation IDF (2005).

RESULTS

The age-adjusted prevalence of the metabolic syndrome was 11.8%, whereas ethnic-specific prevalence was 10.3% in Han ethnic group and 13.7% in Hui ethnic group. Components of MS and MS were more common in Hui ethnic group than Han ethnic group. The mean levels and prevalence of abnormal value increased with increasing age in both ethnic groups (Cochran-Artimage test for trend, Hui ethnic group P < 0.05, Han ethnic group P < 0.01).

CONCLUSIONS

The prevalence of MS was high in rural residents' adults in Ningxia. Clustering of MS components and MS was increased with age. The components of MS have big differences among different ethnic groups.

Metabolic syndrome, endothelial injury, and subclinical atherosclerosis in patients with systemic lupus erythematosus

OBJECTIVES

To study the link between metabolic syndrome (MetS), endothelial injury, and atherosclerosis in patients with systemic lupus erythematosus (SLE).

METHODS

Consecutive SLE patients without a history of arterial thrombosis were screened for atherosclerosis at the carotid and coronary arteries by B-mode ultrasound [intima-media thickness (IMT)] and multidetector computed tomography (MDCT) scan (Agatston calcium scores), respectively. Plasma levels of homocysteine, high-sensitivity C-reactive protein (hsCRP), soluble vascular cell adhesion molecule (sVCAM)-1, P-selectin, and soluble thrombomodulin (sTM) were assayed. Patients were stratified according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria for MetS, using the Asian criteria for abdominal obesity. Risk factors for atherosclerosis were studied.

RESULTS

Of the 123 SLE patients (93% women; age 47.9+/-11 years; SLE duration 10.9+/-7.0 years) studied, 20 (16.3%) had MetS. The prevalence of MetS in the SLE patients was significantly higher than in 492 age- and sex-matched healthy controls (9.6%; p=0.03). Coronary calcification and abnormal carotid IMT were detected in 38 (31%) and 72 (59%) of SLE patients, respectively. Patients with MetS had a significantly higher Agatston score (69.5+/-95 vs. 16.4+/-57; p=0.03) and a numerically higher carotid IMT (p=0.43) than those without. In a logistic regression model, the MetS [odds ratio (OR) 3.11, 95% confidence interval (CI) 1.01-9.59, p=0.049] was associated with coronary atherosclerosis after adjustment for age and other risk factors. In addition, patients with MetS had significantly higher levels of hsCRP (p=0.002), homocysteine (p=0.03), and sTM (p=0.01).

CONCLUSIONS

The MetS is more prevalent in SLE patients than the general population and is associated with endothelial injury and coronary atherosclerosis. More aggressive control of risk factors is justified in these patients.

Waist circumference, body mass index and waist to hip ratio for prediction of the metabolic syndrome in Chinese

BACKGROUND AND AIMS

To explore the ability of waist circumference (WC), body mass index (BMI) and waist to hip ratio (WHR) to predict two or more non-adipose components of the metabolic syndrome (MetS) among individuals aged 18-85 in North China.

METHODS AND RESULTS

This study is a cluster sample survey of 101,510 individuals, complete data are 75,788 subjects, 59,874 males and 15,914 females. Their ages were 51.9+/-12.7 years (males) and 48.7+/-11.5 years (females). Receiver operating characteristic (ROC) analysis was used to examine discrimination and find optimal cut off values of WC, BMI and WHR to predict two or more non-adipose components of MetS. The area under the ROC curve (AURC) for WC (0.694) and BMI (0.692) in females showed no difference. In males BMI (0.657) had a better discrimination than WC (0.634). WHR was weaker in both sexes. The optimal cut off value of WC in males (86.5 cm) was higher than in females (82.1cm); and that of BMI was about 24 kg/m(2) in both genders. The optimal cut off values of WC, BMI, and WHR, increased with age in both sexes.

CONCLUSIONS

BMI and WC are more useful than WHR for predicting two or more non-adipose components of MetS. Cut off values for WC in males, and those of BMI and WHR in both sexes are lower than that in present MetS criteria; WC in females is slightly higher. Cut off values of WC, BMI and WHR were increased with age in the Chinese.

Postprandial glucose improves the risk prediction of cardiovascular death beyond the metabolic syndrome in the nondiabetic population

OBJECTIVE

With increasing evidence about the cardiovascular risk associated with postprandial nonfasting glucose and lipid dysmetabolism, it remains uncertain whether the postprandial glucose concentration increases the ability of metabolic syndrome to predict cardiovascular events.

RESEARCH DESIGN AND METHODS

This was an observational study of 15,145 individuals aged 35-75 years without diabetes or cardiovascular diseases. Postprandial glucose was obtained 2 h after a lunch meal. Metabolic syndrome was diagnosed using the criteria of the U.S. National Cholesterol Education Program Adult Treatment Panel III. Cardiovascular and all-cause deaths were primary outcomes.

RESULTS

During a median follow-up of 6.7 years, 410 individuals died, including 82 deaths from cardiovascular causes. In a Cox model adjusting for metabolic syndrome status as well as age, sex, smoking, systolic blood pressure, LDL, and HDL cholesterol levels, elevated 2-h postprandial glucose increased the risk of cardiovascular and all-cause death (per millimole per liter increase, hazard ratio 1.26 [95% CI 1.11-1.42] and 1.10 [1.04-1.16], respectively), with significant trends across the postprandial glucose quintiles. Including 2-h postprandial glucose into a metabolic syndrome-included multivariate risk prediction model conferred a discernible improvement of the model in discriminating between those who died of cardiovascular causes and who did not (integrated discrimination improvement 0.4, P = 0.005; net reclassification improvement 13.4%, P = 0.03); however, the improvement was only marginal for all-cause death.

CONCLUSIONS

Given the risk prediction based on metabolic syndrome and established cardiovascular risk factors, 2-h postprandial glucose improves the predictive ability to identity nondiabetic individuals at increased risk of cardiovascular death.

High-density lipoprotein-cholesterol trajectory pattern, associated lifestyle and biochemical factors among Taiwanese

BACKGROUND

Little is known about high-density lipoprotein-cholesterol (HDL-C) trajectory patterns among ethnic Chinese in Taiwan, or the effects of lifestyle and biochemical measurements on these trajectory patterns.

METHODS AND RESULTS

This longitudinal study was based on 330 adult participants who underwent biochemical measurements annually from 2003 to 2006. As time progressed, HDL-C increased significantly; women had a consistently higher value (10 mg/dl) than men. An increase of 1 kg/m(2) in body mass index was associated with -1.00 +/-0.25 mg/dl HDL-C for women (P=0.0001) and -0.78 +/-0.11 mg/dl for men (P<0.0001). Current smoking was inversely associated with HDL-C in men only. Systolic blood pressure and exercise frequency were positively associated with HDL-C in men only. Compared with non-smokers, participants who smoked had a lower HDL-C level of -8.42 +/-4.90 mg/dl in women (P=0.09) and -3.60 +/-0.94 mg/dl in men (P=0.0001). In contrast, a 1-h increase in exercise frequency every week was related to an increased HDL-C level of 0.38 +/-0.28 mg/dl for women (P=0.18) and 0.53 +/-0.14 mg/dl for men (P=0.0001).

CONCLUSIONS

An increase in HDL-C was shown over a 4-year period and gender-specific lifestyle factors were associated with HDL-C concentration among ethnic Chinese in Taiwan.

The metabolic syndrome

The "metabolic syndrome" (MetS) is a clustering of components that reflect overnutrition, sedentary lifestyles, and resultant excess adiposity. The MetS includes the clustering of abdominal obesity, insulin resistance, dyslipidemia, and elevated blood pressure and is associated with other comorbidities including the prothrombotic state, proinflammatory state, nonalcoholic fatty liver disease, and reproductive disorders. Because the MetS is a cluster of different conditions, and not a single disease, the development of multiple concurrent definitions has resulted. The prevalence of the MetS is increasing to epidemic proportions not only in the United States and the remainder of the urbanized world but also in developing nations. Most studies show that the MetS is associated with an approximate doubling of cardiovascular disease risk and a 5-fold increased risk for incident type 2 diabetes mellitus. Although it is unclear whether there is a unifying pathophysiological mechanism resulting in the MetS, abdominal adiposity and insulin resistance appear to be central to the MetS and its individual components. Lifestyle modification and weight loss should, therefore, be at the core of treating or preventing the MetS and its components. In addition, there is a general consensus that other cardiac risk factors should be aggressively managed in individuals with the MetS. Finally, in 2008 the MetS is an evolving concept that continues to be data driven and evidence based with revisions forthcoming.